This study retrospectively evaluates the clinical outcomes of definitive volumetric modulated arc therapy (VMAT) for high-risk or very high-risk locoregional prostate cancer patients from an Asian institution. Consecutive patients who received VMAT (76 Gy in 38 fractions) between January 2017 and June 2022 were included. Whole pelvic radiotherapy (WPRT) (46 Gy in 23 fractions) was employed for clinically node-negative disease (cN0) and a Roach estimated risk of ≥15%, as well as simultaneous integrated boost (SIB) of 55–57.5 Gy to node-positive (cN1) disease. The primary endpoint was biochemical relapse-free survival (BRFS). Secondary endpoints included radiographic relapse-free survival (RRFS), metastasis-free survival (MFS) and prostate cancer-specific survival (PCSS). A total of 209 patients were identified. After a median follow-up of 47.5 months, the 4-year actuarial BRFS, RRFS, MFS and PCSS were 85.2%, 96.8%, 96.8% and 100%, respectively. The incidence of late grade ≥ 2 genitourinary (GU) and gastrointestinal (GI) toxicity were 15.8% and 11.0%, respectively. No significant difference in cancer outcomes or toxicity was observed between WPRT and prostate-only radiotherapy for cN0 patients. SIB to the involved nodes did not result in increased toxicity. International Society of Urological Pathology (ISUP) group 5 and cN1 stage were associated with worse RRFS (p< 0.05). PSMA PET-CT compared to conventional imaging staging was associated with better BRFS in patients with ISUP grade group 5 (p= 0.039). Five-year local experience demonstrates excellent clinical outcomes. PSMA PET-CT staging for high-grade disease and tailored pelvic irradiation based on nodal risk should be considered to maximize clinical benefit.
本研究回顾性评估了亚洲某机构对高危或极高危局部区域前列腺癌患者实施确定性容积调强弧形放射治疗（VMAT）的临床结局。纳入2017年1月至2022年6月期间连续接受VMAT治疗（76 Gy/38次分割）的患者。对临床淋巴结阴性（cN0）且Roach预估风险≥15%的患者采用全盆腔放疗（WPRT）（46 Gy/23次分割），同时对淋巴结阳性（cN1）病灶给予55–57.5 Gy的同步整合推量（SIB）。主要终点为生化无复发生存期（BRFS），次要终点包括影像学无复发生存期（RRFS）、无转移生存期（MFS）和前列腺癌特异性生存期（PCSS）。共纳入209例患者。中位随访47.5个月后，4年精算BRFS、RRFS、MFS和PCSS分别为85.2%、96.8%、96.8%和100%。晚期≥2级泌尿生殖系统（GU）和胃肠道（GI）毒性发生率分别为15.8%和11.0%。在cN0患者中，WPRT与单纯前列腺放疗的肿瘤结局或毒性无显著差异。对受累淋巴结的SIB未导致毒性增加。国际泌尿病理学会（ISUP）第5组和cN1分期与较差的RRFS相关（p<0.05）。与传统影像分期相比，PSMA PET-CT分期在ISUP分级第5组患者中与更好的BRFS相关（p=0.039）。五年本地经验显示出优异的临床结局。建议考虑对高级别疾病进行PSMA PET-CT分期，并根据淋巴结风险定制盆腔照射方案，以最大化临床获益。
肿瘤(癌症)患者之家